动脉栓塞治疗前列腺增生12例

目的探讨动脉栓塞治疗良性前列腺增生(BPH)的方法及疗效。方法经穿刺活检确诊BPH患者12例,行动脉造影,确定为前列腺供血动脉后,经导管注入聚乙烯醇(PVA)和明胶海绵颗粒进行栓塞。对患者手术前后国际前列腺症状评分(I-PSS)、生活质量评分(QOL)、最大尿流率(Qmax)、剩余尿(RU)进行比较,并经直肠超声、CT观察前列腺大小、血流变化以评价疗效。结果对12例患者的21支前列腺优势供血动脉进行了栓塞治疗。栓塞的前列腺供血动脉为髂内动脉5支、膀胱下动脉9支、阴部内动脉5支、闭孔动脉2支。单侧栓塞3例,双侧栓塞9例。术后I-PSS、QOL、Qmax、RU,从术前的24.2分、4.8分、9.6ml/s、138ml,分别降至4.8分、1.3分、18.9ml/s、3ml;术后彩色多普勒监测前列腺内血流信号明显减弱、最大血流速度从术前的(19.3±9.8)cm/s减慢到(10.0±8.9)cm/s;B超或CT检查前列腺体积从术前的平均127.6ml缩至65.1ml,缩小51%。结论动脉栓塞治疗BPH是一种创伤小、疗效好、安全性强,并发症少的新方法,具有良好的临床应用价值。     

前列腺动脉造影表现及方法探讨

目的　通过动脉造影了解前列腺供血动脉造影表现并探讨前列腺动脉造影方法。方法　对 6 2例前列腺肥大和前列腺癌患者进行了选择性和超选择性前列腺动脉造影。结果　造影显示存在前列腺动脉 ,前列腺血供主要来自于膀胱大动脉、阴部内动脉和前列腺动脉 (80 % )。熟练掌握插管技术和良好的DSA设备可成功进行前列腺动脉造影。结论　前列腺动脉造影可帮助了解前列腺血供来源、数量 ,对前列腺疾病的良恶性鉴别具有重要意义。     

直肠癌术前介入化疗及栓塞的临床价值

目的 :评价直肠癌术前介入化疗及栓塞的意义 ,初步探讨栓塞后的最佳手术时间。方法 :采用Seldinger技术经股动脉插管 ,分别行肠系膜下动脉及双侧髂内动脉造影后 ,选择进入直肠上动脉及双侧直肠下动脉和 /或髂内动脉脏支 ,行药物灌注和栓塞。全部病例均于栓塞术后 72h内手术。结果 :11例直肠上段癌均见直肠上动脉增粗、迂曲 ,不规则的肿瘤血管及肿瘤染色 ;7例直肠中下段癌见直肠下动脉和 /或髂内动脉脏支增多 ,新生的异常肿瘤血管及肿瘤染色 ,栓塞后造影示肿瘤供血血管闭塞。手术中见直肠肠管肿胀、苍白、病灶段与正常肠管分界较清楚、肿块易于剥离 ,术中出血明显减少 ,未发现肠管缺血坏死。结论 :直肠癌术前化疗及栓塞可提高手术切除率 ,减少术中出血 ,提高远期疗效 ,且栓塞后 72h内为较佳的手术时间。     

子宫动脉DSA造影解剖分析及其临床意义

目的：探讨子宫肌瘤患者的血管造影表现及其诊断与介入治疗中的价值。方法：70例患者，经临床症状，彩超和（或）凹检查确诊子宫肌瘤，单发肌瘤52例，多发肌瘤18例；其中黏膜下肌瘤7例，肌壁间肌瘤51例，浆膜下肌瘤12例。经右侧或左侧股动脉穿刺插管，导管分别插至双侧子宫动脉造影，观察内容包括：子宫动脉的起源及其走行、分布、血供程度、肌瘤表现和特点，然后进行栓塞治疗。结果：①大多数患者子宫动脉大部分发自髂内动脉的臀下动脉阴部干，其次为髂内动脉主干和臀上动脉；②子宫肌瘤供血情况分为：a、一侧子宫动脉供血为主型。b、双侧子宫动脉均衡供血型。c、单纯一侧子宫动脉供血型；③大多数子宫动脉发出卵巢支，子宫肌瘤栓塞术不能避免栓塞卵巢支。结论：子宫动脉栓塞是治疗子宫肌瘤的一种安全有效的方法，熟悉子宫肌瘤的血管解剖对提高技术成功率、合理选用栓塞方法有重要意义。     

子宫动脉造影解剖分析及对栓塞治疗子宫肌瘤的指导意义

目的研究子宫肌瘤血管造影表现特点及其临床价值。方法75例患者,经临床症状,彩超和(或)CT检查确诊子宫肌瘤,其中黏膜下肌瘤9例,肌壁间肌瘤50例,浆膜下肌瘤16例;单发肌瘤21例,多发肌瘤54例。经右侧股动脉穿刺插管,导管分别插入双侧子宫动脉造影,观察内容包括：子宫动脉的起源及其分支、不同类型子宫肌瘤的血管造影表现,然后进行栓塞治疗。结果①大多数患者子宫动脉大部分发自髂内动脉的臀下动脉阴部干,其次为髂内动脉主干和臀上动脉。②子宫肌瘤供血情况分为：a、一侧子宫动脉供血为主型。b、双侧子宫动脉均衡供血型。c、单纯一侧子宫动脉供血型。③卵巢支的栓塞几乎不可避免,其临床后果仍存在争议。结论子宫动脉栓塞是治疗子宫肌瘤的一种安全有效的方法,熟悉子宫肌瘤的血管解剖对提高技术成功率、合理选用栓塞方法有重要意义。     

巨大肝癌的多支动脉供血及其在栓塞治疗中的意义

目的：探讨巨大肝癌的多支动脉供血规律以及多支动脉供血在肝癌动脉栓塞治疗中的意义。材料与方法：７２例巨大（直径≥１０ｃｍ）肝癌，动脉栓塞术前选择性肝动脉及肝外动脉造影，观察多支动脉供血情况，并同时进行多支动脉栓塞治疗。结果：７５．０％（５４／７２）巨大肝癌存在多支动脉供血，其多支动脉来源为规则的肝总动脉的肝动脉、变异性动脉及肝外动脉三种类型，且多支动脉供血与肿瘤部位密切相关；随访２７例化疗栓塞效果，     

骨盆肿瘤血管造影特点及临床意义

目的　通过分析骨盆肿瘤血管造影表现及供血特点 ,指导动脉栓塞治疗和手术治疗 ,强调肿瘤血管“多支栓塞”的重要性。方法　对 12例骨盆肿瘤患者进行了局部动脉灌注化疗和碘油栓塞治疗 ,其中纤维肉瘤 1例 ,软骨肉瘤、骨肉瘤各 2例 ,转移瘤 7例 ,治疗前均行髂内动脉、髂外动脉和 /或腰动脉造影 ,治疗后造影复查血管闭塞及碘油沉积情况。术后观察临床效果。结果　 ( 1)血管造影表现特点 :a“多源多支”供血 :髂内动脉、髂外动脉及腰动脉均参与骨盆肿瘤供血 ;b“富血管性”表现 ;c肿瘤染色区域明显大于骨破坏区。 ( 2 )栓塞结果 :每例均进行了 2支以上供养血管栓塞 ,复查见供养血管完全闭塞 ,肿瘤染色明显减少 ,碘油沉积良好。 ( 3)临床效果 :临床效果显著 ,疼痛减轻 ,肿块缩小 ,无严重并发症发生。结论　骨盆肿瘤的供血特点对指导临床治疗具有重要意义。     

原发性肝癌肝外血供的血管造影分析及介入治疗

目的 探讨原发性肝癌的肝外血供的血管造影表现及其对肝癌介入治疗的意义.方法 本组32例原发性肝癌患者行常规腹腔动脉造影及肝外血供探查,并对其行超选择性插管及化疗栓塞治疗(TACE).结果 32例患者共见37支肝外营养血管,分别为肠系膜上动脉12支,右膈下动脉9支,左膈下动脉1支,胃左动脉6支,胰十二指肠动脉弓2支,胃网膜动脉2条,胃十二指肠动脉2支,右胸廓内动脉1支,右肋间动脉1支,脾动脉1支.大多数肝外血供为肠系膜上动脉和右膈下动脉;4支肝外营养血管因未能成功行超选择性插管而只予化疗药灌注治疗,其余33支肝外血供均行超选择性插管和化疗栓塞治疗.结论 原发性肝癌的肝外血供较为常见和多变,对肝外血供的化疗栓塞在肝癌的介入治疗中具有重要的意义.     

膈下动脉参与供血的大咯血的急诊介入治疗

目的探讨膈下动脉（IPA）参与供血的大咯血患者的动脉造影表现及急诊栓塞治疗的疗效。方法回顾性分析15例IPA参与供血的大咯血患者的临床资料。选用明胶海绵条、聚乙烯醇（poly vinylal cohol,PVA）颗粒及弹簧圈选择性栓塞供血的IPA,对动脉造影的表现及治疗结果进行总结及评价。结果选择性IPA造影显示为IPA增粗,分支增多、紊乱及新生血管形成。IPA供血区对比剂外溢10例,肿瘤血管及肿瘤染色3例,IPA与肺动脉分流2例。本组患者均行供血的IPA栓塞术,同时栓塞支气管动脉5支、肋问动脉4支,胸廓内动脉4支,栓塞术后咯血停止。术后随访1～2年,所有患者无再次咯血。结论IPA可参与大咯血的供血,漏栓IPA是栓塞治疗大咯血失败或复发大咯血的原因之一,行急诊IPA栓塞是一种安全、有效的治疗手段。     

产后大出血：卵巢动脉造影和栓塞术的意义

目的:观察卵巢动脉(OA)作为产后出血来源的血管造影表现,评价经导管栓塞OA参与出血的安全性和疗效。材料和方法:对7例OA作为产后出血来源的患者进行了选择性OA造影和栓塞术。栓塞OA的材料有明胶海绵碎粒、PVA、微型钢丝圈。结果:选择性OA造影显示造影剂外溢至宫腔6例、OA直接参与子宫异常血管供血1例。补充栓塞参与出血或病变的OA后出血立即停止,住院期间未再复发出血,未发生与栓塞术相关的并发症。结论:OA可作为产后出血的主要供血动脉,是导致常规栓塞两侧髂内动脉-子宫动脉不能控制出血的原因之一。如发现OA参与产科出血性病变的供血,补充做OA栓塞术是安全和有效的。     

动脉栓塞治疗男性先天性盆腔动静脉畸形一例

报道1例长期原因不明肉眼血尿多囊肾患者。影像检查显示两侧盆区动静脉畸形(CPAVM)。经超选择栓塞髂内动脉8支分支血尿治愈,随访6个月,血尿无复发。文献复习表明CPAVM发病甚少,形态多样。介入治疗是有效的微创方法。     

C臂类CT血管成像技术在前列腺动脉栓塞术中的应用价值

目的:探讨C臂类CT血管成像技术在前列腺动脉介入栓塞术中的应用价值。方法:2017年9月-2020年1月32例患者(前列腺增生23例,前列腺癌9例)在本院行前列腺动脉栓塞治疗,所有患者在术中行髂内动脉DSA检查,31例行双侧、1例行单侧前列腺动脉超选择性DSA及C臂类CT血管成像检查。由一位影像诊断医师及一位介入手术医师(均为副主任医师及以上职称)对两种检查图像进行分析,比较两种方法对辨认前列腺动脉(PA)的准确性、前列腺的染色情况及吻合支的显示情况等。结果:32例患者共超选择了76支血管,共发现60支PA,16支非靶器官动脉。其中,DSA组共确认50支PA、敏感度为83.3%(50/60),类CT组共确认60支PA、敏感度为100%(60/60),两组间差异具有统计学意义(χ²=10.909,P=0.001);DSA组共确认11支非靶器官动脉(膀胱支、直肠支及会阴支等)、特异度68.8%(11/16),类CT组共确认16支非靶器官动脉、特异度100%(16/16),两组间差异具有统计学意义(P=0.043)。DSA组发现前列腺动脉与邻近动脉间的吻合支8支(13.3%),类CT组发现17支(28.3%),两组间差异具有统计学意义(χ²=4.093,P=0.035)。类CT组可以通过多容积重建技术完整显示整个前列腺的染色情况。结论:在前列腺动脉介入栓塞术中借助C臂类CT血管成像技术可以准确辨认前列腺动脉及其吻合支的情况,减少对前列腺动脉的漏栓,预防非靶器官动脉的误栓,有助于提高前列腺疾病栓塞治疗的效果和降低并发症。     

Value of "additional arterial embolization" to bilateral internal iliac TAE in patients with severe pelvic fractures

Transcatheter arterial embolization (TAE) of the bilateral internal iliac arteries has been shown to be of great value in controlling retroperitoneal massive hemorrhage associated with pelvic fractures. It has recently been reported, however, that TAE of only the bilateral internal iliac arteries sometimes fails to stabilize the patient's hemodynamics. The purpose of the present study was to evaluate "additional arterial embolization" to the bilateral internal iliac TAE in hemodynamically unstable cases. Sixty-eight patients who underwent emergency TAE following severe pelvic fractures were reviewed. Additional arterial embolization of the lumbar arteries in four patients, middle sacral arteries in two and inferior epigastric artery in one was carried out following bilateral internal iliac TAE. The damage to these arteries was associated with fractures of the lumbar costal process, sacrum, pubis, etc. The patients were in stable condition after the procedure, and no significant complication was experienced. When fractures and dislocations of the above-mentioned bones are seen on plain X-ray films and arterial bleeding is identified by angiography, additional embolization of the arteries should be performed immediately.     

The Role of Accessory Obturator Arteries in Prostatic Arterial Embolization

In 9 of 491 patients (1.8%) who underwent prostatic arterial embolization (PAE) for benign prostatic hyperplasia from March 2009–November 2013, prostatic arteries arose from the external iliac artery via an accessory obturator artery (AOA). Computed tomography angiography performed before the procedure identified the variant and allowed planning before the procedure. The nine AOAs were catheterized from a contralateral femoral approach. Bilateral PAE was technically successful in the nine patients. There was a mean decrease in international prostate symptom score of 6.5 points and a mean prostate volume reduction of 15.1% (mean follow-up, 4.8 mo) in the nine patients.     

Prostatic Arterial Supply: Anatomic and Imaging Findings Relevant for Selective Arterial Embolization

PurposeTo describe the anatomy and imaging findings of the prostatic arteries (PAs) on multirow-detector pelvic computed tomographic (CT) angiography and digital subtraction angiography (DSA) before embolization for symptomatic benign prostatic hyperplasia (BPH).Materials and MethodsIn a retrospective study from May 2010 to June 2011, 75 men (150 pelvic sides) underwent pelvic CT angiography and selective pelvic DSA before PA embolization for BPH. Each pelvic side was evaluated regarding the number of independent PAs and their origin, trajectory, termination, and anastomoses with adjacent arteries.ResultsA total of 57% of pelvic sides (n = 86) had only one PA, and 43% (n = 64) had two independent PAs identified (mean PA diameter, 1.6 mm ± 0.3). PAs originated from the internal pudendal artery in 34.1% of pelvic sides (n = 73), from a common trunk with the superior vesical artery in 20.1% (n = 43), from the anterior common gluteal–pudendal trunk in 17.8% (n = 38), from the obturator artery in 12.6% (n = 27), and from a common trunk with rectal branches in 8.4% (n = 18). In 57% of pelvic sides (n = 86), anastomoses to adjacent arteries were documented. There were 30 pelvic sides (20%) with accessory pudendal arteries in close relationship with the PAs. No correlations were found between PA diameter and patient age, prostate volume, or prostate-specific antigen values on multivariate analysis with logistic regression.ConclusionsPAs have highly variable origins between the left and right sides and between patients, and most frequently arise from the internal pudendal artery.     

分析子宫动脉起源及开口情况对栓塞治疗子宫肌瘤的意义

目的对子宫动脉起源及开口情况进行分析,提高栓塞治疗子宫肌瘤的成功率。资料与方法71例子宫肌瘤患者进行双侧髂内及子宫动脉造影,观察子宫动脉起源及开口情况,并比较用不同投照角度造影对子宫动脉的显示情况。结果40.8%子宫动脉起源于臀下阴部干;29.6%源于臀下动脉;18.3%源于阴部内动脉,8.5%源于脐动脉,2.8%髂内动脉主干。47.3%子宫动脉在正位造影显示较好,86.2%子宫动脉在10°~30°右斜位造影或10°~30°左斜位造影显示较好。结论多数患者子宫动脉发自髂内动脉分支;斜位造影显示子宫动脉优于正位造影。     

Prostatic gland arteriography. Vascular supply, diagnosis and differential diagnosis of adenoma and carcinoma of the prostate (author's transl)]

Vascular supply and architecture of the prostate are studied by 100 arteriographic surveys of the pelvis. The prostatic arterial supply can be differentiated in urethral and capsular branches. In a further group of 38 patients with prostate gland disease selective bilateral arteriographies of the internal iliac arteries were performed. In 18 patients with the clinical diagnosis of prostatic adenoma, arteriography detected a carcinoma of the prostate gland. These diagnoses were proven by microscopy. In 10 patients with clinically suspected carcinoma, 5 were diagnosed by arteriography as malignant and also confirmed microscopically. The predominant angiographic criteria of prostatic carcinoma are irregular spotted stain of the involved parenchyma, hypervascularity of the urethral vascular branches, and pathological vessels.     

Angiographic Findings Relevant to Prostatic Artery Embolization in Patients with Prostate Cancer

The 2014–2018 angiograms of 58 patients with prostate cancer were retrospectively analyzed to illustrate angiographic findings during prostatic artery embolization. Arteriovenous fistulae were observed in 6 patients (6/58, 10.3%), with no difference between patients with or without prior iodine-125 seeds implantation (5/48, 10.4% vs 1/10, 10.0%; P > .05); tumor staining was not detected. The origins of the prostatic arteries included the internal pudendal artery (n = 45, 32.4%), the superior vesical artery (n = 38, 27.3%), the obturator artery (n = 28, 20.1%), the gluteal-pudendal trunk (n = 21, 15.1%), the inferior gluteal artery (n = 3, 2.2%), the accessory pudendal artery (n = 3, 2.2%), and the superior gluteal artery (n = 1, 0.7%).     

髂内动脉输注和栓塞对盆腔肿瘤诊治的价值

目的:通过分析髂内动脉造影和栓塞治疗效果,结合CT、腔镜及术后病检结果,初步评估髂内动脉输注和栓塞治疗盆腔肿瘤的价值。方法:12例盆腔肿瘤患者,行双侧髂内动脉造影、输注后,作单侧或双侧供血血管的超选择插管栓塞,重点观察其血管造影表现和栓后临床症状的改善情况、CT扫描变化及术后病理检查结果,评估其疗效。结果:9例富血管肿瘤(6例膀胱癌、2例宫颈癌及1例子宫内膜癌)显示有典型的血管增多、增粗、不规则且有显著的肿瘤染色而得以诊断,而后行栓塞治疗,6例栓后手术病理发现瘤体不同程度的坏死,3例未行手术的患者,B超、CT发现瘤体明显缩小,血尿或阴道出血停止并维持达二月。3例少血管肿瘤(膀胱癌),没有明显的血供异常,仅行化疗并在1周内手术。结论:髂内动脉化疗输注和栓塞对盆腔肿瘤有较好的治疗价值。